title: ACR appropriateness criteria palpable breast masses.
abstract: A palpable breast mass is one of the most common presenting features of breast carcinoma. However, the clinical features are frequently nonspecific. Imaging performed before biopsy is helpful in characterizing the nature of the mass. For women with clinically detected breast masses, the vast majority will require evaluation with ultrasound. Diagnostic mammography is the initial imaging modality of choice for women aged ≥ 40 years; ultrasound is typically necessary unless a definitively benign mass is identified as the etiology of the clinical finding. For evaluating women aged <30 years and women who are pregnant or lactating, ultrasound is used for initial evaluation. For women aged 30 to 39 years, either ultrasound or diagnostic mammography may be used for initial evaluation. MRI is rarely indicated to evaluate a clinically detected finding. Biopsy is indicated for masses with suspicious features. Short-term follow-up is a reasonable alternative to biopsy for solid masses with probably benign features suggesting fibroadenoma. Correlation between imaging and the clinical finding is essential. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: University of Virginia Medical Center, Charlottesville, Virginia. Electronic address: jah7w@virginia.edu.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Harvey
authors.forename: Mary C
authors.initials: MC
authors.lastname: Mahoney
authors.forename: Mary S
authors.initials: MS
authors.lastname: Newell
authors.forename: Lisa
authors.initials: L
authors.lastname: Bailey
authors.forename: Lora D
authors.initials: LD
authors.lastname: Barke
authors.forename: Carl
authors.initials: C
authors.lastname: D'Orsi
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hayes
authors.forename: Peter M
authors.initials: PM
authors.lastname: Jokich
authors.forename: Su-Ju
authors.initials: SJ
authors.lastname: Lee
authors.forename: Constance D
authors.initials: CD
authors.lastname: Lehman
authors.forename: Martha B
authors.initials: MB
authors.lastname: Mainiero
authors.forename: David A
authors.initials: DA
authors.lastname: Mankoff
authors.forename: Samir B
authors.initials: SB
authors.lastname: Patel
authors.forename: Handel E
authors.initials: HE
authors.lastname: Reynolds
authors.forename: M Linda
authors.initials: ML
authors.lastname: Sutherland
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Haffty
mesh_terms: D016504:Breast Self-Examination / Q000592:standards*; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D010173:Palpation / Q000592:standards*; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards*; D014481:United States
keywords: Appropriateness criteria; breast mass; breast self-examination; breast ultrasound; clinical breast examination; mammography